Burden of health‐care of carers of children with sickle cell disease in Nigeria

Sickle cell anaemia in children is characterised by recurrent crises that frequently involve intensive medical care which may impact on the health and well‐being of their carers. The psychosocial impact of sickle cell disease on 67 carers of children with sickle cell disease attending the Paediatric Haematology/Oncology clinic of the University College Hospital, Ibadan, Nigeria, was determined between February and May 2007 using a structured questionnaire adapted from an instrument earlier validated for the study of carer burden in sickle cell disease and relevant to the Nigerian culture. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 15.0. Demographic factors as well as frequency of hospitalisations and blood transfusions were each categorised into groups and the Mann–Whitney U‐test was used to test for differences in stress scores between any two groups while the Kruskal–Wallis test was used to test for differences in more than two groups. Level of statistical significance was set at P < 0.05. Family finances were adversely affected in 39 (58.2%) families. Financial stress was frequently associated with a history of two or more hospitalisations in the previous year and more so in families with more than three children. Majority (80.6%) of the carers said they had minimal or no difficulty coping with their children. There was also a significant correlation between financial stress and difficulty in parental coping. Caring for the illnesses in the children often caused disruptions in family interactions; worst in the first year after diagnosis and improved over the years. Regular assessment of psychosocial areas of need is necessary to guide provision of necessary support.     

Acute bronchiolitis in tropical Africa: A hospital-based perspective in Ibadan,Nigeria

In a 30-month prospective study of severe acute lower respiratory infections in hospitalized pre-school Nigerian children, acute bronchiolitis was diagnosed in 67 cases; 19 (28.4%) and 2 (3.0%) of these had concomitant pneumonia or croup, respectively. The peak prevalence was in the wet (rainy) season (May–October). The male/female (M:F) ratio in infants ≤ 6 months was 2.9:1, differing significantly from the 1.1:1 in older subjects (P = 0.04). None of the subjects had severe malnutrition. Neither a high fever (≥ 39°C), nor tachypnea on admission was significantly correlated with co-existing pneumonia. Of the 29 subjects in whom it was possible to explore viral immunofluorescence studies and/or serodiagnosis, we identified 26 viral identifications in 18 (62.1%) cases; 6 (20.7%) had ≥ 2 viruses. Respiratory syncytial virus was identified in 11 (38.0%) of the 29 cases, and parainfluenza virus (PIV) types 1, 2, and 3 in 10 (34.5%). PIV type 3 accounted for 7 cases, including 3 with bacteremia. Bacterial isolates were made in 9 (21.4%) of 42 blood cultures and in the only lung aspirate; Staphylococcus epidermidis and Staphylococcus aureus accounted for 4 and 3 cases, respectively. Although bacteremia was 2.9 times more common in cases with co-existing pneumonia or croup, the respective frequency of virus-positive cases and that of bacteremia was not significantly different between cases with bronchiolitis alone and those with associated pneumonia or croup. No deaths were recorded, but subjects aged > 6 months had a significant shorter hospital stay than those < 6 months old (P = 0.02). Despite the limited sample size, our findings reflect the etiological importance of the paramyxoviruses and the seasonal pattern of bronchiolitis in tropical Africa. Pediatr Pulmonol. 1996; 22:236–247. © 1996 Wiley-Liss, Inc.